Topic

Insurance Approval

A collection of 1841 issues

How to Get Cresemba (Isavuconazole) Covered by UnitedHealthcare in Washington: Prior Authorization Guide

Answer Box: Quick Path to Cresemba Coverage UnitedHealthcare requires prior authorization for Cresemba (isavuconazole) in Washington. Your fastest path: (1) Confirm diagnosis codes B44.0 (invasive aspergillosis) or B46.x (mucormycosis), (2) Document any voriconazole contraindications or failures, and (3) Submit PA request via UnitedHealthcare Provider Portal within 180 days.

How to Get Gattex (teduglutide) Covered by Blue Cross Blue Shield of Illinois: Prior Authorization, Appeals, and State Protections

Answer Box: Getting Gattex Approved in Illinois To get Gattex (teduglutide) covered by Blue Cross Blue Shield of Illinois, you need prior authorization showing short bowel syndrome with parenteral nutrition dependence. Submit clinical documentation including PN logs, specialist attestation, and failed alternative therapies. If denied, you have 60 days to

How to Get Dojolvi (Triheptanoin) Covered by UnitedHealthcare in Pennsylvania: Complete PA Guide & Appeal Scripts

Answer Box: Getting Dojolvi Covered by UnitedHealthcare in Pennsylvania Quick Path to Approval: UnitedHealthcare requires prior authorization for Dojolvi (triheptanoin) with molecular confirmation of long-chain fatty acid oxidation disorder (LCFAOD), prescription by a board-certified medical geneticist, and no concurrent MCT oil use. If denied, Pennsylvania's new external review

How to Get Daybue (Trofinetide) Covered by Cigna in New Jersey: Prior Authorization, Appeals, and Cost-Saving Strategies

Answer Box: Getting Daybue Covered by Cigna in New Jersey Daybue (trofinetide) requires prior authorization from Cigna with specific documentation for Rett syndrome patients ≥2 years old. Your fastest path to approval: (1) Have your neurologist submit PA with confirmed MECP2 genetic testing and Clinical Severity Scale scores, (2) coordinate

Getting Emgality (galcanezumab-gnlm) Covered by Humana in California: Prior Authorization, Appeals, and Cost Savings

Answer Box: Getting Emgality Covered by Humana in California Emgality (galcanezumab-gnlm) requires prior authorization from Humana and is typically placed on a high-tier formulary. Your fastest path to approval: have your doctor submit a PA request documenting your migraine diagnosis, failure of 2+ preventive medications, and medical necessity. If denied,

How to Get Hetlioz (Tasimelteon) Covered by UnitedHealthcare in Florida: Complete PA Guide and Appeals Process

Quick Answer: Getting Hetlioz Covered by UnitedHealthcare in Florida Hetlioz requires prior authorization from UnitedHealthcare through OptumRx. The fastest path to approval: (1) Confirm your diagnosis qualifies—Non-24-hour sleep-wake disorder in totally blind adults or Smith-Magenis syndrome sleep disturbances, (2) Document failed melatonin therapy or contraindications, and (3) Have a

Get Kuvan (Sapropterin) Covered by Humana in California: Complete Prior Authorization Guide

Answer Box: Getting Kuvan Covered by Humana in California Kuvan (sapropterin dihydrochloride) requires prior authorization for all Humana plans in California. Your fastest path to approval: (1) Have your prescriber submit the Humana Medicare Part D Prior Authorization Form with complete PKU documentation to fax 877-486-2621, (2) Include proof of

Get Arikayce Covered by Blue Cross Blue Shield Michigan: Prior Authorization Forms, Appeals, and State Review Process

Quick Answer: Arikayce requires prior authorization from Blue Cross Blue Shield of Michigan, typically with step therapy requirements. Start by having your doctor submit a PA request with documentation of refractory MAC lung disease and failed standard therapies. If denied, you have 127 days to file an external review with

Do You Qualify for Prolastin-C Coverage by Blue Cross Blue Shield in New York? Decision Tree & Next Steps

Answer Box: Getting Prolastin-C Covered in New York To get Prolastin-C covered by Blue Cross Blue Shield in New York, you need: (1) Confirmed severe alpha-1 antitrypsin deficiency (Pi*ZZ genotype), (2) FEV1 between 30-65% predicted, and (3) clinical evidence of emphysema. First step today: Contact your pulmonologist to order

Myths vs. Facts: Getting Idelvion (Albutrepenonacog Alfa) Covered by Humana in Pennsylvania

Answer Box: Get Idelvion Covered by Humana in Pennsylvania Fastest path to approval: Submit prior authorization through Humana Provider Portal with factor IX deficiency documentation, bleeding history, and inhibitor status. If denied, appeal within 65 days—Pennsylvania's external review program has a 50% overturn rate. Start today: Contact